Healthcare Provider Details

I. General information

NPI: 1699141432
Provider Name (Legal Business Name): SUPPORTIVE CONNECTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SE OSCEOLA AVE SUITE 5
OCALA FL
34471-2171
US

IV. Provider business mailing address

PO BOX 1746
OCALA FL
34478-1746
US

V. Phone/Fax

Practice location:
  • Phone: 352-301-7902
  • Fax: 352-354-9191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11304
License Number StateFL

VIII. Authorized Official

Name: TASHA JONNI BROWNING
Title or Position: OWNER
Credential: PHD
Phone: 352-427-6586